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Pilot study of targeted skeletal radiation therapy for bone-only metastatic breast cancer.

AbstractPURPOSE:
Bone-targeted radiation therapy is an attractive strategy for addressing bone disease with minimal systemic toxicity. This pilot study was designed to determine the safety and efficacy of (166)Holmium (Ho)-DOTMP for irradiating malignant cells and adjacent marrow in women with bone-only metastatic breast cancer.
PATIENTS AND METHODS:
Subjects included 6 women aged < or = 65 years with breast cancer and bone-only metastases at M. D. Anderson Cancer Center. The activity of (166)Ho-DOTMP was calculated to deliver a therapeutic absorbed dose of 22 Gy (n = 3) or 28 Gy (n = 3) to the marrow. Treatment was followed by autologous stem cell transplantation to circumvent the anticipated myelosuppresion. Median follow-up time was 40 months.
RESULTS:
All subjects showed prompt hematologic recovery. No patient experienced grade 3/4 acute toxicity aside from myelosuppression. Two patients developed hemorrhagic cystitis 2 years after therapy. One patient developed myelodysplastic syndrome but was found to have had pre-existing trisomy 8. Two patients remained progression free without evidence of disease for more than 6 years. Five women experienced disease relapse (4 at extraosseous sites) and died of progressive disease. Median time to progression was 10.4 months.
CONCLUSION:
The approach of bone-targeted radiation therapy with (166)Ho-DOTMP had an acceptable toxicity profile, and sustained complete response was obtained in 2 of 6 patients. We are conducting a phase II study to evaluate the efficacy of targeted skeletal radiation therapy for treating bone-only metastases.
AuthorsNaoto T Ueno, Jonas A de Souza, Daniel Booser, Kazutaka Nakayama, John Madewell, Richard E Wendt 3rd, Gabriel N Hortobagyi, Donald Podoloff, Richard E Champlin
JournalClinical breast cancer (Clin Breast Cancer) Vol. 9 Issue 3 Pg. 173-7 (Aug 2009) ISSN: 1938-0666 [Electronic] United States
PMID19661041 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
Chemical References
  • Organophosphorus Compounds
  • 1,4,7,10-tetraazacyclododecane-1,4,7,10-tetrakis(methylenephosphonic acid)
Topics
  • Adult
  • Bone Neoplasms (secondary, therapy)
  • Bone and Bones (drug effects, radiation effects)
  • Breast Neoplasms (pathology)
  • Combined Modality Therapy
  • Female
  • Humans
  • Middle Aged
  • Organophosphorus Compounds (adverse effects, pharmacokinetics)
  • Peripheral Blood Stem Cell Transplantation
  • Pilot Projects
  • Treatment Outcome

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